Baysari Melissa, Westbrook Johanna, Day Richard
Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Stud Health Technol Inform. 2011;169:935-9.
This research explored the decision-making process of selecting medicines for prescription on hospital ward-rounds. We aimed to determine when and with whom medications were discussed, and in particular, whether shared decision making (SDM) occurred on ward-rounds. As a low level of computerized decision support was in place in the hospital at the time, we also examined whether the decision support aided in any medication discussions. Fourteen specialty teams (46 doctors) were shadowed by the investigator while on ward-rounds and all verbal communication about medications was noted. Most medication discussions took place away from the patient bedside and the majority took place between two or more doctors. While a great deal of doctor-patient communication regarding medications took place on ward-rounds, very little of this comprised SDM. More frequently, doctors informed patients of the medications they would be or were currently taking. The computerized decision support had little impact on treatment decision-making. While the value of SDM is often acknowledged in the literature, it appears to be rarely practiced on hospital ward-rounds.
本研究探讨了医院查房时处方用药选择的决策过程。我们旨在确定何时以及与何人讨论用药，特别是查房时是否发生了共同决策（SDM）。由于当时医院的计算机化决策支持水平较低，我们还研究了决策支持是否有助于任何用药讨论。14个专科团队（46名医生）在查房时被研究者跟踪，记录了所有关于用药的口头交流。大多数用药讨论是在远离患者床边的地方进行的，并且大多数发生在两名或更多医生之间。虽然在查房时有大量关于用药的医患沟通，但其中很少涉及共同决策。更常见的情况是，医生告知患者他们将要或正在服用的药物。计算机化决策支持对治疗决策影响甚微。虽然共同决策的价值在文献中经常得到认可，但在医院查房中似乎很少实践。
